In a recent article in the Sacramento Bee, clinician decision tools accompanying a continuing medical education program will help with treatment decisions offering advanced treatment options for breast cancer patients.
The current guidelines list more than 20 regimens as options for adjuvant breast cancer treatment. One option to help health professionals and patients with early cancer discuss the risks and benefits of getting additional therapy (adjuvant therapy: usually chemotherapy, hormone therapy, or both) after surgery is Adjuvant!Online.
The goal of Adjuvant! is to help health professionals make estimates of the risk of negative outcome (cancer related mortality or relapse) without systemic adjuvant therapy, estimates of the reduction of these risks afforded by therapy, and risks of side effects of the therapy. These estimates are based on information entered about individual patients and their tumors (for example, patient age, tumor size, nodal involvement, histologic grade, etc.) These estimates are then provided on printed sheets in simple graphical and text formats to be used in consultations.
Although Adjuvant!Online provides risk assessment based on patient characteristics and expected risk reduction, it lacks guidance on specific treatment choice. To address this uncertainty in cancer treatment, Clinical Care Options (CCO), a leader in education for healthcare professionals, and several esteemed breast cancer experts, created an interactive, online tool for guiding choice of systemic adjuvant treatment (adj TX) for patients with early breast cancer (EBC).
Research on this online tool was recently presented at the American Society of Clinical Oncology (ASCO) annual meeting. The poster was entitled, “Utilization and clinical practice impact of Abstract.” The program was supported by education grants from Genentech and Pfizer.
Methods and Study
Six experts made first and second treatment recommendations for 864 patient case variations based on age, menopausal status, nodes, tumor grade/size, and receptor status (HR, HER2). Their choices were incorporated into an interactive decision support tool. Users of the tool entered specific patient characteristics and their own choice of therapy; then, expert recommendations were displayed for a patient case variation matching the user’s case, and users were asked if those recommendations impacted their treatment decision. Expert and participant responses were analyzed.
Essentially, the clinician simply enters specific patient and tumor characteristics, indicates what therapy he/she thinks is optimal, and then receives expert guidance from 6 faculty members on the optimal treatment for that specific patient
Results
More than 2000 users accessed the tool, including 1043 physicians. When prompted, “Did the tool impact your adjuvant treatment decision?” 65% of physicians (n = 669) said “yes” for at least one case.
As a result, the researchers concluded that the tools “provide expert guidance on adjuvant treatment of breast cancer that positively impact clinicians’ treatment decisions and improve patient care.”
Peter Ravdin, MD, Ph.D., Director of the Breast Cancer Program, at the University of Texas Health Science Center at San Antonio, Texas, noted that the research showed “important differences between user choice of therapy and expert-recommended therapy.”
One notable difference was that clinicians using the tool made initial treatment choices of some regimens that were never selected by experts. For example, the regimen of cyclophosphamide- doxorubicin(AC)-paclitaxel administered every 3 weeks was selected in 20% of node-positive cases by participants, even though the evidence is clear that AC-paclitaxel weekly is a superior regimen.
Linda Coogle, President and Chief Operations Officer for CCO, recognized that by “using a combination of CCO’s complex technology and their sophisticated approach to medical education, they have not only identified gaps in clinician practice for breast cancer care but have also been able to provide long-needed access to 6 expert opinions on-demand right from the point of care in the form of this tool.”
Conclusion
Ultimately, with 65% of physician’s treatment choice impacted by this tool, it is clear that this commercially supported educational program positively affected clinicians’ treatment decisions and improved patient care. This creative program, that was only possible due to the creative energy of an editorial team working with faculty and sophisticated technology, once again demonstrates the power and importance of continuing medical education (CME) for physicians and their patients.